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Friday, April 17, 2015

Prescription Philling A la Carte

A Conversation with myself...
Me, Myself, and I: Welcome to Professional Label Slappers Anonymous. What brings you here today?
CP: I believe that we need to change the way we get reimbursed. We need to change the way we charge for prescriptions.
MMI: Just how would you accomplish this?
CP: We need to set up a menu. Something like a fast food's dollar menu.
MMI: Okay…Curious to see where this goes. Explain.
CP: There will be two sides to the board: FAST and ACCURATE.
On the FAST side, we will offer the following options:
1. selection of A medication, not necessarily the one prescribed for you.
2. professionally applied (read: slapped) label.
3. immediate checkout where you will pay AWP Plus $250.00
4. one signature to receive your prescription (which absolves the pharmacy of any liability).
MMI: Why so much?
CP: Convenience charge. Plus it pays for the lawyers.
MMI: Okay. What does the ACCURATE side get me?
CP: It's not what you think. For those that still want something quick and easy, we offer similar pricing. We still charge AWP PLUS $250.00.
MMI: How can you justify that?
CP: Simple. You ask for a prescription where all I do is "slap a label on it" or "dump pills in a little bottle". I can do that quite easily. Hence the reason we offer option #1-Fast. BUT…if you want me to put the correct information on the label, like your name, correct medication, strength, quantity, directions, refills, prescriber, etc. then that will cost you. If you wish me to check for interactions, make sure your prescriber isn't trying to kill you with poor penmanship or computer skills, or to check your allergies for you, then it will cost you.
MMI: I thought this was going to be less expensive. Why do you keep adding charges?
CP: Because the final step on the ACCURATE side is Billing Your Insurance. Once we bill your insurance, you will have a more acceptable, possibly, copay.
MMI: I see.
CP: Now all I have to do is bring this to everyone and let the (m)asses see it.
MMI: Insurances won't go for that.
CP: But they should. Imagine billing everything a la carte. For every part of the process, we are allowed to bill. Like prescribers and hospitals where every person that touches a patient gets to bill the insurance, there would be billing codes for each part of the prescription. Bottle, label, directions, DUR checks, tech time for data entry, tech time for filling, pharmacist verification--all billable.
MMI: You know they'd set limits, right?
CP: Yep. To the $10 minimum cost to fill a prescription with no drug in it, MINUS 20%, PLUS a $0.25 dispensing fee.
MMI: If you're lucky.

Tuesday, April 14, 2015

Pick Your Patients

We had a wonderful mother come into our pharmacy the other night. Her preferred pharmacy was too far and we are located just a mile or two from her homestead. She required a prescription that would need filled multiple times per month and the long commute to preferred location would be more expensive and frustrating to make for an entire year. She asked if we could help her. We did. We offered options for her. She "bothered" us with some OTC questions while we were finishing her prescriptions. She asked a couple more questions, thanked us profusely, and individually, as she left and that was how our night ended…

…and we got to wondering: Why can't we have all our patients be like her? We should be able to have a draft for patients every year.

If insurances can dictate which pharmacies patients may use, the pharmacies should be able to exercise the same right. We would send letters to patients in May/June announcing which pharmacy drafted them for the next calendar year/season which runs July 1st through June 30th.

CP's Pharmacy selected you to represent their team in this year's All County Phantasy Pharmacy season.
Walgreen's would like to welcome you to its 2015-2016 team. Congratulations!
CVS took Extra Care in choosing YOU for their 2015-2016 roster. Welcome aboard!
Rite Aid says you have the Rite Stuff to be part of their 2015-2016 Wellness+ Patient Panel!
WalMart wanted you for their 2015-2016 Wellness Plan! Here's your blue replica smock.
Target tapped you to be part of the 2015-2016 RedCards.

Each pharmacy would get to keep up to a certain percent of their current patients each season. As with all drafts, there are some risks involved. Those late-round picks can either score big for you or be a total bust, filling no prescriptions or being horrible patients. There would also be a period of free agency where patients could try out other pharmacies. Patients could ask for their release from their pharmacy while they also may be traded between pharmacies. This would help offset any losses due to moving or insurance changes. Patients would have to clear waivers if they were released locally whether due to insurance changes or relocation.

It would certainly help with "customer service" and inventory as you will always know who is coming in for what for the entire year. Imagine the inventory and budget control you'd have!

Monday, April 13, 2015

Worth A(nother) Shot

7. Payroll: (People who can't understand why we cannot give them 90 days on prescriptions written for 30 days with 11 refills.) Call your HR department and ask them to change your checks for you. You are paid $20.00 an hour and you are paid once a week. Ask if they will change it so you make $80.00 an hour for one week each month so you don't have to cash as many checks. It's the same thing, right?

8. Grocery Store: I was making breakfast this morning and I dropped a few eggs on the floor. I need them to finish my poached eggs and french toast. Can you just pull 3 eggs out of a carton and leave them at customer service? I'm on my way there right now.

9. DMV: Why didn't you call to tell me my tags had expired? You sent me a letter? I don't read that crap. I don't have time. Can't you just automatically renew them for me? Don't you have one of those Courtesy Renewal programs? The car dealer I bought my car from said I'd be driving this car for the next 10 years. I guess I'll just get pulled over and ticketed and it'll all be your fault.

10. Law Enforcement: "Do you know why I pulled you over? Your license tags are expired." Why do I have to renew them every year? I'm driving the same car. Nothing's changed. I have the same license plates I've had for years. No one told me they expire. Can't you call the DMV and get them renewed for me? They issued it the last time. They have all my information. It's not my job to get my tags renewed for my car. I guess I'll just crash without them.

11. Pizza Shop: When I go in to pick up my order and they ask how many pizzas and 2-litres, just to make sure the order is correct, I will yell and scream that I don't know. Someone else in the house placed the order and I'm just picking it up. It's your job to know what pizzas I take. I will then drive home and call back and yell that they forgot my Margherita Pizza and Garlic Parmesan wings which are what I wanted.

12. Dr. Zoffis: Next time I'm in the prescriber's office checking in, I am going to complain about everything they ask…"Can you verify your DOB?" It's in your computer! I've been coming here for years. I have an appointment. Don't you know who I am? New insurance? Yeah, but I don't have the card. Can't you just look it up? Preferred pharmacy? The one where I work! It's in the system. I was just here last week!

13. Liquor Store: You don't need to see my ID. I don't care if it is the law. I don't carry my license with me because I'm afraid someone will steal my wallet and take my identity. They let me buy it without a license last week when I was in here and they never card me at the ABC stores. You should have it on file from the last time. Can't you just look it up in "The System"?

14. Anyone: Why didn't you respond to my email? I just sent it. I watched myself hit "enter" and heard the "whoosh" as it got sent. Why haven't you responded yet? I need an answer now and you said you always check your email right away. I don't care that the phone was ringing as I sent the email. What's taking you so long?

If nothing else, pharmacy patients have taught me over the years it is much easier to fight and complain and yell and scream and get rewarded for bad behaviour than it is to just comply with what is being asked.


Friday, April 10, 2015

It's Worth a Shot

On my next day off, I am going to attempt to live one day as my pharmacy patients live theirs. I am going to pick one idea and practice it wherever I go that day. Any good idea needs scientific research to substantiate it. Patients' expectations should be no different. That means this Friday will be Practice Pharmacy Patient Practices and Postulate Possible Plausibility (P-6) Day.
I am going to model my study after the conversation I had on Monday: 

Unrealistic Expectations: "I dropped 1 of my Ramipril capsules in the toilet. Can you replace it for me?" (I know, first time for everything.) 
CP: No. That's not how it works. 
UE: "Well, it was worth a shot." 
CP: Not really. In what reality do you live? 

That's when I decided, maybe I've been doing it wrong all these years. Here's my plan: 
1. Grocery Store: I dropped my gallon of milk on the floor of my kitchen, you'll replace it, right?

2. Bank: I ran out of money in my account but I get paid next week. Can you just give me a few hundred dollars until then? I come here all the time.

3. Gas Station: I'm in town on a business trip and only need a few gallons to get back home. I don't want a full tank. Can't you just give me a few at no charge?

4. Movie Theatre: <buys ticket, watches movie> That wasn't the movie I wanted to see. Can I return my ticket and see another movie? OR I didn't like that movie. I didn't realise it had Tom Cruise in it. I want to watch another movie without him in it.

5. Restaurant: I am going to ask for "the usual". I come here every week and they know me. They will reply with, "Of Course, CP! We shall bring it post haste as we knew you were coming". Once the plate is presented to me, I shall call the maitre'd over to the table and loudly complain that I am no longer eating this. I changed my usual order yesterday and though I did not in any way communicate that decision to the loyal staff who know me so well, I fully expect them to return my plate of food, send me a new dinner with the correct order, pay for their mistake, and offer me free dessert and after dinner aperitifs.

6. Lowe's: I bought a ceiling fan here from you and I always get the 4 light bulbs replaced here. They all burn out at different times. Can you make it so they all burn out at the same time? I hate having to make multiple trips down here every couple years to just get one bulb.

Monday, April 6, 2015

Obviously

To illustrate normal directions that, upon closer inspection, are unnecessarily long or redundant, I offer the following:

1. Zithromax Z-Pak--"Take according to package directions…until gone."
Okay, if they take it according to the directions, it will be all gone.

"Under redundant in the dictionary, it says 'see redundant'". (Robin Williams)

2. Prednisone Tapers and Medrol Dose Packs that end with "…THEN STOP or D/C".
If you give a patient exactly enough tablets to last the course, which the majority of these do, then on the last day, they will take their last tablet. Is it truly necessary to state "then stop"? Should it not be quite obvious? Even taking into account the Stupidity Curve, I have yet to receive a phone call that goes like this:

CP: How may I help you?
Taper Taker: I have a question about my steroid.
CP: Okay.
TT: It said to take 4 for 3 days, then 3 for 3 days, then 2 for 3 days, then 1 for 3 days.
CP: Okay. That's a statement, not a question.
TT: I received 30 tablets.
CP: Again, statement.
TT: Well it's been 12 days and I took them all.
CP: You're getting there. I can almost hear the inflection that alerts me to an audible question mark.
TT: What do I do now?
CP: What do you mean?
TT: I followed the directions for 12 days. Now what do I do?
CP: Be well? Live long and prosper?
TT: I need direction in my life.
CP: Had I taken the time to put "THEN STOP" on your label, would that have been sufficient to prevent this call?
TT: Yes. Then I would have known exactly what to do.
CP: Okay. Please stop.
TT: The medication?
CP: No. Calling me.

My partner received a prescription for this same Prednisone taper while I happened to be cherry picking  the e-rx queue. Her directions ended up reading:
"Take 4 tabs for 3 days, then 3 tabs for 3 days, then 2 tabs for 3 days, then 1 tab for 3 days then stop taking because, quite frankly, you will be out of medication so even if there were more directions, you wouldn't have any medication left."

Tuesday, March 24, 2015

Own Your Stupid

Strange days have found us. Strange days have tracked us down. They're going to destroy our casual joy…
I sometimes wonder what my topic or story will be for tomorrow's post. Sometimes I write days and weeks ahead. Other times, I make it up right before I set the post. Yesterday provided today's "Why do I care?" moment, while I was floating to another store.

CP: How may I hel…
Self-Obsessed Blonde: I don't like this pharmacy.
CP: Um...Thanks for telling me?
SOB: You don't have a drive-thru.
CP: I know. I love that. That's why…
SOB: I had to walk all the way to the back.
CP: We're actually on the side, but no bother. So why are you here, exactly? Other than to prattle on about our inconveniences?
SOB: My friend asked me to bring this here because she likes this pharmacy. I can't see why.
CP: And I can't see how you two are friends.
SOB: What?
CP: Nothing.
SOB: I would never come here again.
CP: And that would make each and every one of my days brighter were I never to see you again. And you didn't have to walk all the way to us. You could have commandeered a motorized scooter. You could have skipped or jumped or traipsed or moonwalked, or danced, or sashayed to the pharmacy. Personally, I find myself reenacting the Ministry of Silly Walks routine as I make my way to the pharmacy. Sometimes it makes me late though. Sorry. You were complaining?
SOB: It's rather a pain to get back here and I have to wait.
CP: Do tell. Where is this Eden of pharmacies located? How can you have found the one pharmacy where there is no waiting, there are no lines, there is a drive-thru, and all your needs are met instantly? Never mind. I know the answer.
SOB: Well…
CP: Shh. Good Girl. You are THAT patient. The one everyone talks about before she arrives and after she leaves. They know you are coming so they hurriedly shuffle your prescriptions through to completion so as to ensure they don't have to deal with you any longer than possible. I bet they even draw straws or shout "not it!" or put their fingers to their noses to choose the loser who has to wait on you. Fortunately for me, you are not my patient and your friend is. Thanks for that.

Seriously though…Who has the moxie to enter a business and begin complaining? You already don't shop here. I don't need to know why you don't shop here. I would be happier never having had to hear this story about why you are here now. Go sit in the corner until I finish her prescription and think of other reasons to not like us. Write them down for me so I can forward them to corporate.

Monday, March 23, 2015

Door-to-Door

In a world overcrowded with pharmacies trying to one-up each other, one pharmacist is on a mission. His goal today? Selling Comprehensive Medication Reviews door-to-door vis-a-vis vacuum and encyclopedia salesmen of decades past. Today we join him on his quest for the Holy Grail (someone to say "yes").

1. Would you be interested in a CMR today? I could just come inside and demo my services for you. Just 25 minutes of your time and I can have you on your way to a happier, healthier you. Right here I see that you are taking a Statin. Did you know…? <door slams>

2. <Tips fedora>
Good day, ma'am. I would like to show you the power of the new CMR 3000. With this lovely service, you too can turn your frown upside down. Side effects from medication? Too many medications? Drug interactions from all those tablets you have to take 8 times a day? No more! With the CMR 3000 we can reduce those unwanted outcomes, cut your daily regimen, and minimize the burden on you so you can get on with your life and enjoy each day better. May I come in? <door slams>

3. Are you one of the millions of people out there who are going to die? My name is Syrio Forel and I say: "Not today". With a quick investment of just 20 minutes, I can demonstrate for you the powers of the CMR 3K and how it can save your life. <hears the phrase, "Chopper, sick balls!" and takes off running.>

4. Do you do drugs? Can I have some?

Wednesday, March 18, 2015

Place No Faith in Humanity

"I will work to elevate you, just enough to bring you down."

Hope. Most days start with it. I'm not talking going all Snow White and singing with the birds hopeful, but more like Episode IV, A New Hope sort of optimism.

Did you ever think to yourself today was going to be your day? I go to work every day thinking to myself that it's a new day. It's like starting out the school year with straight A's. Even though you haven't had a class yet, it's up to you to keep the grades. Then something happens and it all goes away. Like work. Stupid happens and your day goes from newborn Bambi optimism to "BAM" dead mom Bambi misery.
It's times like these that we have to remember that our fellow humans are out there, populating the world, waking up, dressing themselves, operating vehicles, working jobs, navigating the daily grind, feeding themselves…and asking questions like these:

1.  Why didn't you call to tell me my bottle was empty?
2.  Why didn't you tell me my bottle says "no refills"?
3.  Why didn't you tell me I was out of insulin?
4.  Why didn't you tell me I had no syringes left to inject my insulin I use every day?
5.  It says "do not drink alcohol with this medication". Can I have just a couple beers tonight?
6.  It says "Take with food". Is toast okay?
7.  My copay is $10. Why are you charging me $30 for 3 prescriptions?
8.  I heard red wine is good for the heart and I don't want to see a doctor. What kind do you recommend?
9.  I broke a clot in my foot. Should I wash it?
10. What's a prescription? Is that that paper I get from the doctor?
11. There was a man there in the pharmacy. Or maybe it was a girl.
12. I filled an application down there. Does it interact with anything?
13. Can I smoke marijuana if I use the Nicotine Patch?
14. The wait time is 20 minutes? Can I go home and come back tomorrow?
15. The directions say 2 times a day but my doctor said I could "eat 3 of these a day".
16. This is called a drive-THRU, right? Not a pull-up-and-wait?